Clinical Research Directory

Inclusion Criteria: * Age range is from 18 to 40 years old. * No sex predilection * Patients seeking root canal treatment. * restorable teeth. * Positive patient acceptance for participating in the study. * patients able to sign informed consent. * Systematically healthy patient (ASA I, Il). * Patient who can understand the numerical rate scale and sign an informed consent. * Mandibular first molar teeth with pain on bite or percussion * Preoperative sharp (moderate or severe) pain. * Vital response of pulp tissue to cold pulp tester (ethyl chloride spray). * widening in periodontal membrane space in radiographic appearance. Exclusion Criteria: * Patients with American Association of Anesthesiologists (ASA) classifications other than ASA 1 \& Il * Patients who have already ingested preoperative medication, such as analgesics, non-steroidal, or steroidal anti-inflammatory drugs, within 12 hours of the start of treatment. * This was done to prevent any misinterpretation of the diagnosis or post-treatment pain severity, as these drugs substantially lower post-endodontic pain (Jorge-Arajo et al.,2018). * Patients with NSAID allergy. * Patients having two or more adjacent teeth needing root canal therapy * Pregnant patients. * Patients with bleeding disorder. * Patients with long-term corticosteroid use. * Teeth having: * Necrotic pulp. * History or presence of swelling or fistulous tract. * Acute/chronic periapical abscess. * Mobility more than grade 1. * Pocket depth of more than 5mm * No possible restorability. * Previous root canal treatment. * Periapical radiolucency. * External or internal resorption * Vertical root fracture. * TMJ problems, bruxism, clenching or traumatic occlusion. * Inability to understand and perform the given instructions.